title: Identification of stroke mimics in the emergency department setting.
abstract: OBJECTIVE
  Previous studies have shown a stroke mimic rate of 9%-31%. We aimed to establish the proportion of stroke mimics amongst suspected acute strokes, to clarify the aetiology of stroke mimic and to develop a prediction model to identify stroke mimics.
  
  
  METHODS
  This was a retrospective cohort observational study. Consecutive "stroke alert" patients were identified over nine months in a primary stroke centre. 31 variables were collected. Final diagnosis was defined as "stroke" or "stroke mimic". Multivariable regression analysis was used to define clinical predictors of stroke mimic.
  
  
  RESULTS
  206 patients were reviewed. 22% were classified as stroke mimics. Multivariable scoring did not help in identification of stroke mimics. 99.5% of patients had a neurological diagnosis at final diagnosis.
  
  
  CONCLUSIONS
  22% of patients with suspected acute stroke had a stroke mimic. The aetiology of stroke mimics was varied, with seizure, encephalopathy, syncope and migraine being commonest. Multivariable scoring for identification of stroke mimics is not feasible. 99.5% of patients had a neurological diagnosis. This strengthens the case for the involvement of stroke neurologists/stroke physicians in acute stroke care.
authors.affiliation: Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Republic of Ireland. ; Department of Neurology, Mayo Clinic Arizona, U.S.A.
authors.forename: W Oliver
authors.initials: WO
authors.lastname: Tobin
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Hentz
authors.forename: Bentley J
authors.initials: BJ
authors.lastname: Bobrow
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
keywords: stroke; stroke mimic; transient ischemic attack